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Leadership > Exam 3 content: Quality Control (Ch. 23) > Flashcards

Exam 3 content: Quality Control (Ch. 23) Flashcards

1
Q

what is quality control, who is it rendered to, and what are the activities used for?

A

Specific type of controlling

Activities used to:
Evaluate
Monitor
Regulate

Services rendered to consumers

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2
Q

what are the components of an effective quality control program?

A

Top Level Administrators Support.

Organizational Fiscal & Human Services Commitment.

Quality goals reflect excellence vs minimums.

Ongoing Process

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3
Q

what are the L&M roles in quality control?

A

Communicate findings & role model high standards of care to subordinates.

Ensures that patients receive acceptable levels of quality care.

Participates in nursing-sensitive patient outcomes research.

Encourages benchmarks for quality improvement best-performing organizations

Creates a work culture that addresses near misses, medical errors and adverse events.

Use critical event analysis (CEA) or root cause analysis (RCA), when standards are not met.

Discuss quality control findings & regulations.
Establish research base practices.

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4
Q

what is the definition of quality health care?

A

Institute of Medicine (IOM):
Degree of rendered health services increase the likelihood of desired health outcomes consistent with professional knowledge.

Implications of Definition
Outcomes is one indicator of quality
Quality care must be consistent with current professional knowledge

Defining quality care is difficult

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5
Q

what is Quality control as a process? how is it measured?

A

Process of measuring quality care.

3 basic steps
  1. Identify the standard, or criterion
    Benchmarking-process of measuring practices against best-performing organiz.
  2. Collect information to determine if standard is met
  3. If criterion is not met, corrective action
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6
Q

what are the steps in auditing quality control?

A

Establish control criteria

Identify information relevant to criteria

Determine strategies to collect the information

Collect and analyze information

Compare the information with established criteria

Make a decision about quality

Provide information or take corrective actions regarding findings

Reevaluation

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7
Q

what is the definition for development of standards?

A

Predetermined level of excellence

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8
Q

what are the distinguishing development of standards?

A

Predetermined

Established by an authority

Communicated and accepted by those affected

Measurement tool

No one set of standards

Standards of practice
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9
Q

what is the development of standards: ANA?

A

Develops professional standards of care

ANA publishes standards for varied specialty areas
~ Scope & Standards of Practice & Professional Performance
~ Nursing Administrative Scope & Standards of Practice & Professional Performance
~ Many other specialties
~ All of these standards set high expectations for nursing, organizations, & units nationwide

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10
Q

what are the development of standards: Organization?

A

Outline practice guidelines within institution

They minimize or maximize quality of service performance

Allows measurement of unit & individual performance level

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11
Q

what are Clinical Practice Guidelines (CPG)?

A

it’s other contemporary standards

Clinical Practice Guidelines(CPG)
- Agency for Healthcare Research & Quality (AHRQ)
~ AHQR & AMA & American Association of health Plans
` Launched the National Guideline Clearing House (NGC)

Some guidelines based on expert vs research

Strength of evidence is missing

Some are not useful, lack flexibility

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12
Q

what is an audit? what are the different types?

A

Audits as a quality control tool

Audit:
Systematic, official review of a record, process, structure, environment or account to evaluate performance.
Controlling process to determine quality of service

3 types:
Retrospective
Concurrent
Prospective

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13
Q

what is outcome audit?

A

it is a quality control audit (there are three types)

  1. Outcome Audit
    - End result of care
    - Change in pt. health status
    - Most valid, complex

Nursing Sensitive:
Fall rates, nosocomial infection rates, pressure ulcers, physical restraint use, & patient satisfaction rates

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14
Q

what is process audit?

A

it is a quality control audit (there are three types)

  1. Process Audit:
    • Measure how nursing care is delivered
    • Denotes relationship of process to quality care
    • Critical pathways & standardized clinical guidelines

Measure if practice standards are implemented:

- Vital signs checked according to policy
- Medication reconciliation
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15
Q

what is structure audit?

A

it is a quality control audit (there are three types)

  1. Structure Audit:
    • Relationship between quality of care & appropriate structure
    • Resource inputs where care is delivered, environment
    • Includes existing elements prior to & separate of the pt. contact
    • Structural standards
      ` Call light & in reach, water at reach
    • Structural measures
      ` Staffing ratio, staffing mix, ER wait times,& availability of fire extinguishers in patient care areas
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16
Q

what are standardized nursing languages?

A

Provides consistent nsg. Terminology to document care

12 ANA approved

  1. Nursing Minimum Data Sets (NMDS)
    ` Uniform definitions & categories to meet needs of data users. Shared language. Compares nursing effectiveness, costs, outcomes across settings & nsg. interventions
  2. Nursing Interventions Classifications (NIC)
    ` Research-based classification system
    ` Provides a common, standardized language
    ` Consist of independent & collaborative interventions of nurses in all specialties.
    ` Linked with NANDA, NMDS, & outcomes
  3. International Council of Nurses (ICN)
    ` International Classification for Nursing Practice (ICNP).
    ` Global compositional terminology for nsg.
    ` Represents a complementary part of professional health for decision making & policy development
17
Q

what does the QA model target?

A

targets current quality

18
Q

what does the QI model target?

A

targets ongoing and cont. improv. quality

19
Q

what is total quality management (TQM)?

A

a quality improvement model

  • Continuous quality improvement (CQI)
  • Production & service focuses on individual
  • Quality can always be better
  • Empowerment of employees
20
Q

what is Toyoto Production System (TPS)?

A

a quality improvement model

  • Eliminate waste, & focus on efficient production
  • Have caregivers to solve problems when they occur, find root of problem to limit reoccurrences, & prevents larger problem
21
Q

who should be involved in quality control?

A

Everyone

Provides employees feedback

Transforming Care at Bedside (TCAB):
~ Engages leaders, empowers frontline & engages family & patients in dec. making
~ End result-improvement in patient safety indicators

Patient Safety Officer

Multidisciplinary Team

Pt. satisfaction may not equate with health

22
Q

what is quality measurement as an organizational mandate?

A

Organizational accountability has increased
Managers must be cognizant of changing governmental & licensing regulations

  1. External Impacts on quality control
    - Government establish guidelines to monitor quality of services
    - Justify need for services
  2. Professional Standards Review Organizations
    - Fed. Gov. mandated certification of admissions
    - Continued review & evaluation of care
    - Analysis of patient, hospital & practitioner
    - New surveillance affected industry
  3. Prospective Payment System
    - Drg’s-Fixed payment to providers
    - Decline quality care
  4. Joint Commission:
    - Accredits more than 20,000 HCO in USA
    - Great impact on planning QC
    - Mandate QA program in hospitals
    - Reviewed care, & evaluations
    - Sentinel event database & RCA plan
    - Sentinel Event Policy
    - Nation’s Most comprehensive data bases
  5. Core Measures (JC)
    - Hospital Quality Measures
    - To better standardize, valid, evidence-based data set
    - Performance measurement requirements
  6. National Patient Safety Goals
    - Promote improvements in patient safety
    - Annually
23
Q

what are the centers for medicare and medicaid services (CMS)?

A

Hospital Quarterly Initiative (HQI)
~ Targeted health outcomes data source
~ Data made available to consumers & media

Pay for Performance/Quality Based Purchasing (P4P) HP get payments for reporting quality info.

Hospital Consumer Assessment of HP & Systems (H-caps) Survey of patient’s hosp. experience
~ 1st National, Standardized Public Reported
~ Incentive to improve quality care

National Committee for Quality Assurance (NCQA)
~ Compare quality of managed care org.
~ M & M only contracts services with NCQA accreditation

Maryland Hospital Assoc. Quality Indicator Project (QI Project)
~ Performance measurement most frequently used by JC requirement

Report Cards
~ Most states require

24
Q

what is an ongoing threat to quality care?

A

medical errors

25
Q

what should you know about medical errors?

A

Ongoing Threat to Quality Care

Rampant in HCDS
To Err is Human Study
    ~ Americans die yearly, med errors
    ~ 8th leading cause of death
    ~ Most errors based on flaws
         ` Developed strategies to fix flaws
                - Create environment for better reporting
                - Leapfrog Initiative

Reporting & analyzing errors:
~ Increase mandatory & voluntary reporting of errors

~ Remove blame from ind. & place on organiz
` Ind. Accountability intact for safe care
` Finding a middle ground

~ Just Culture
` Middle ground between blame free culture & punitive culture

~ Patient Safety & Quality Improvement Act

26
Q

what is Leapfrog group?

A
  • Scientific evidence for safe practices
  • Initiatives reduce medical errors
  • Bar Code System
    ~ FDA-Reduce point of medication errors
    ~ Inherent 5 Rights System
  • Smart Pumps
    ~ IV therapy infusion
    ~ Safety software for advanced infusion

4 Evidence-Based Standards:

  1. Computerized Physician-Provider Order Entry
    ~ Enter orders in computer
    ~ Provides clinical decision support
  2. Evidence-Based Hospital Referral
    ~Specific guidance for proper HCDS selection related to client condition1.
  3. Intensive Care Unit Physician Staffing
    ~ Examines training of personnel
    ~ Intensivists
    ~ Staff organization in ICU
  4. Leapfrog Safe Practices Scores
    ~ National Quarterly Forum (NQF)-Endorse safe practice
    ~ Assesses hospital’s progress on initiatives
27
Q

what should you know about reforming the medical liability system?

A

Medical liability is a potential barrier for achieving quality care
~ Litigious system to uncover & learn from errors
~ Organizational climate change needed
` Employees & patients need to be comfortable in reporting hazards to patient safety
` Need a limitation on fear of personal risks
~ Culture in health care must shift from one of blame to one of supportive for reporting errors

28
Q

what should you know about progress in quality care?

A
  • Gaps remain
  • Crossing the Quality Chiasm: A new health system for the 21st century
    ~ Found huge gaps in preventive, acute & chronic care
  • Healthgrades Study
    ~ Distinguished Hospitals for Patient Safety
    ` Reported potentially preventable deaths
    ~ Improvement shown in mortality rates
  • Incremental, limited progress in medical errors
29
Q

what should you know about integrating L&M in quality control?

A
  • Managers must know standards & develop programs to measure standards
  • Monitoring quality of the product
  • Assess & promote patient satisfaction
  • Managers must use hard data driven quality indicators & update as needed
  • Role model & inspire max standards
  • Risk-taker in a cost containment climate
  • Public Voice, Change Agent & Visionary
  • Continue the dialogue (bolded in ppt?)

Leadership (8 decks)

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